Mobile will be essential to meeting MU Stage 2, improving care coordination

By Neil Versel

Neil_Versel_LargeWe've heard talk for years about patient engagement, but not a whole lot of real progress. Mobile technologies are about to change that, with a substantial boost from Stage 2 of the "meaningful use" EHR incentive program.

To meet Stage 2 requirements, starting in 2014 (or the second year after initially getting to Stage 1),  providers must share patient records with affiliated hospitals and physicians for 65 percent of patient transitions and referrals they handle. This must include 10 percent of transitions outside their organizations to providers using an EHR system from a different vendor.

Also, hospitals and physician practices alike must give 50 percent of their patients the ability to view and download their own medical records through online portals, up from 10 percent in Stage 1. And, perhaps most significantly, 5 percent of patients actually have to log in to those portals for doctors and healthcare organizations to achieve meaningful use.

The 5 percent threshold doesn't sound like much, but I've recently concluded that it truly is a Big Deal. For the first time, EHR adoption isn't completely in the hands of the provider, and that was on the minds of a lot of IT people at the recent College of Healthcare Information Management Executives Fall CIO Forum.

"We have to be very creative in doing this," Pam McNutt, senior vice president and CIO of Methodist Health System in Dallas said at the meeting.

"We're trying to figure out what our strategy is," added Gary Paxson, CIO of White River Health System in rural Batesville, Ark.

Meanwhile, a potentially groundbreaking report from the esteemed Lucian Leape Institute of the National Patient Safety Foundation is calling for healthcare organizations to pick up the pace when it comes to coordinating and integrating patient care.

"Most failures of coordination occur during care transitions, when there is a failure to transfer key pieces of information during handover and to ensure the completion of essential tasks of care," the report said. "Examples include failure to transfer the results of medical tests and even the medical record as a whole, specialists receiving little or no information from referring primary care providers, and inadequate or missing discharge summaries."

The paper didn't explicitly say so, but read between the lines and know that technology is going to have to support  care integration. In fact, that's exactly what one of the authors, former Kaiser Permanente CEO Dr. David Lawrence, told me last week. "You almost cannot do complex medical care without that kind of connectivity" called for in Stage 2, Lawrence said.

And it looks like vendors are taking notice.

Just this week, Buffalo, N.Y.-based Smart Sign Out released an updated version of its iPad app that automates patient handoffs to ensure that essential data gets transferred between all members of each patient's care team. It also lets clinicians enter orders and instructions and share with colleagues.

At CHIME, Albert Oriol, VP and CIO of Rady Children's Hospital in San Diego, showed me how physicians use the Epic Haiku iPhone app to access the hospital's EHR remotely to view clinical summaries, test results and communicate with patients and other clinicians. Oriol said Rady has even connected the mobile system to San Diego County's immunization registry, an important feature for any pediatric hospital.

Just a few weeks earlier, former federal CTO Aneesh Chopra gave a shout-out to Humetrix's iBlueButton, a suite of consumer iPhone and iPad apps that allows doctors and patients to "push" health data securely between their mobile devices during office visits.

I'm still not completely sold on the idea of patient-controlled personal health records doing a lot for interoperability, but, as McNutt said, meeting the Stage 2 standards is going to take some creativity. You have to give iBlueButton and some of these other app developers points for being creative.

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